Medicare Missive...Case of the Week
When to Switch?

Switching from a Medicare Advantage Plan to "Traditional Medicare" or a Supplement with a Drug Plan.

When is the right time to switch?  Will you be able to?

This week I am working with a client by the name of Ron in Wakefield MA.  He and his wife have been covered by Advantage plans for the past several years.  First by one carrier, then when his medicatons & drs changed by another.

He called me last week and said that he has been diagnosed with cancer and the road ahead looks tough.  Surgeries.  Chemo.  Radiation.  

The CT Scan he had last month, mistakenly done out-of-network cost him $1100!

I suggested that now would be the time to consider switching to Traditional Medicare.  Doing so, eliminates the variable co-pays with a fixed monthly payment and NO copays.  Once his annual $226 deductible is covered (one Specialist visit no doubt) he will pay NOTHING(!) for ALL covered medical proceedures and have NO network to worry about. 

On some levels it is a simple math problem.  What is the fixed cost of Traditional Medicare vs the anticipated variable cost of the Advantage Plan?  

Beyond that there is the convenience of not having co-pays or network limitations.  

How can he switch with a cancer diagnosis?  Luckily, MA is one of the states without underwriting!  It simply doesn't matter!  What are the rules in your state?

Additionally, January 1st to March 31st is Advantage Plan Open Enrollment which he was able to take advantage of.

Should he have been on a Supplement from the start?  Do the math?  He has saved $2500/yr for the past 4 years or $10,000!  Minus whatever copays he has had he is way ahead.  Switching him now, that his circumstances have unfortunately changed makes economic sense.  

Next year, when all is well, he can switch back!